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Every service my providers have requested from out-of-network providers have been denied. The most recent request was for a visit to the spasticity clinic at Craig Hospital (I have a totally fused spine and severe back and neck pain as well as myelopathy - in other words spinal cord damage).

Craig Hospital is in network - the nurse practitioner there was more than happy to write an order for the spasticity clinic eval. This time Cigna used the excuse that a NP could not write an order, it has to be from an M.D. And not one of the physicians at Craig Hospital is in-network. I did not ask her to appeal the decision - as one the foremost spinal cord injury centers in the country and with patients clamoring for their services, they do not have the time or the need to fight with Cigna about something this ***.

Last I knew, a NP could do anything a physician can, except surgery. A patient with a spinal injury, living within 10 miles of one of the best centers for treatment of these injuries (an-in-network facility at that) should be able to access their services.

Review about: Cigna Health Insurance.

Reason of review: Not as described.

I didn't like: Referral policies, Inaccurate billing, Authorization process is ridiculous.

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Anonymous
#1570891

It's a Colorado scam--Cigna (and possibly some complicit hospitals) manipulate patients' treatments with the goal of forcing them to be out-of-network. If a patient sees an out-of-network provider, the patient has to pay for it.

Hospitals can bill the patient full price, based on the hospital's Chargemaster list prices--this is contained in the fine print of the consent-to-treat form patients e-sign without getting to read.

The hospital writes off the debt and sells it to a debt buyer like Professional Finance Company for 4.5 cents on the dollar. PFC files suit against the patient, who never received a bill from the hospital, and under Colorado SB 17-216, the medical debt is presumed valid if the debt buyer has notified the patient of the original creditor, the original account number, and the amount.

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